Provider Demographics
NPI:1770027955
Name:MINK, MEGGON NOEL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MEGGON
Middle Name:NOEL
Last Name:MINK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MEGGON
Other - Middle Name:NOEL
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:26106 LEE HWY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7502
Practice Address - Country:US
Practice Address - Phone:276-623-0274
Practice Address - Fax:276-623-0317
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210788225100000X
TN11226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist